MEDICARE: LILA HERRINGTON MS, RD, LD, CSCS,CLT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	864-611	OR

General Provider Information

NPI Number	:	1104232495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILA HERRINGTON MS, RD, LD, CSCS,CLT

Provider Business Mailing Address
First Line	:	155 B AVE
Second Line	:	SUITE 120
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97034-3148
Country	:	US
Telephone Number	:	503-788-9707
Fax Number	:

Provider Business Practice Location Address
First Line	:	155 B AVE
Second Line	:	SUITE 120
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97034-3148
Country	:	US
Telephone Number	:	503-788-9707
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2014
Last Update Date	:	11/18/2022

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